Form DR135 "Formal Complaint of Discrimination" - California

What Is Form DR135?

This is a legal form that was released by the California Department of Rehabilitation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 1999;
  • The latest edition provided by the California Department of Rehabilitation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DR135 by clicking the link below or browse more documents and templates provided by the California Department of Rehabilitation.

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Download Form DR135 "Formal Complaint of Discrimination" - California

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STATE OF CALIFORNIA
DEPARTMENT OF REHABILITATION
FORMAL COMPLAINT OF DISCRIMINATION
*CONFIDENTIAL
DR 135 (Rev. 05/99)
Complainant's Name
Job Title/Classification
Section-District-Branch
Location
Telephone Number
Type of Discrimination Alleged
Discriminatory Action Alleged
Race/Color
Sexual Harassment
Performance Eval/Discipline
Gender
Ancestry/National Origin
Working Conditions
Disability
Religious/Political Opinion
Reasonable Accommodation
Age
Sexual Orientation
Client/Consumer Services
Marital Status
Retaliation
Other:
Specific Group Discriminated Against (e.g., Hispanic, Deaf, etc.)
Date of Most Recent Discriminatory Action
Person Alleged to be Responsible for Discriminatory Action
Job Title/Classification
Section-District-Branch
Location
Telephone Number
Describe the action(s) taken against you and how they adversely affected you. State facts supporting your belief that the
actions were taken because of your protected status. Provide a detailed description. (Attach add'l pages, if necessary.)
Suggest Departmental action which would resolve your complaint.
Complainant's Signature
Date
* For EEO investigation use only. Unauthorized disclosures prohibited.
STATE OF CALIFORNIA
DEPARTMENT OF REHABILITATION
FORMAL COMPLAINT OF DISCRIMINATION
*CONFIDENTIAL
DR 135 (Rev. 05/99)
Complainant's Name
Job Title/Classification
Section-District-Branch
Location
Telephone Number
Type of Discrimination Alleged
Discriminatory Action Alleged
Race/Color
Sexual Harassment
Performance Eval/Discipline
Gender
Ancestry/National Origin
Working Conditions
Disability
Religious/Political Opinion
Reasonable Accommodation
Age
Sexual Orientation
Client/Consumer Services
Marital Status
Retaliation
Other:
Specific Group Discriminated Against (e.g., Hispanic, Deaf, etc.)
Date of Most Recent Discriminatory Action
Person Alleged to be Responsible for Discriminatory Action
Job Title/Classification
Section-District-Branch
Location
Telephone Number
Describe the action(s) taken against you and how they adversely affected you. State facts supporting your belief that the
actions were taken because of your protected status. Provide a detailed description. (Attach add'l pages, if necessary.)
Suggest Departmental action which would resolve your complaint.
Complainant's Signature
Date
* For EEO investigation use only. Unauthorized disclosures prohibited.